Asthma and anesthesia

Describe the etiology of asthma
Describe the etiology of asthma
Lack of exposure to immunologic challenges early in life lead to:

1. TH2-type cytokine response predominance
2. General atopy

This is the most common chronic childhood disease, affecting up to 6 million children
Asthma. Up to 22M in the US have asthma

What is the pathophysiological change that occur with asthma? (2)
Airway inflammation
Nonspecific hyper-irritability of TB tree

What are the clinical features seen in asthma? (3)
What are the clinical features seen in asthma? (3)
1. Bronchoconstriction
2. Airway hyperresponsiveness
3. Airway edema

What are the clinical features of asthma?
Recurrent wheezing
dyspnea
cough
recurrent labored respirations
Accessory muscle use
tachypnea
recurrent chest tightness
prolonged expiratory phase of respiration
fatigue

What conditions can exacerbate symptoms?
Exercise
Viral infections
Allergens
Irritants
Changes in weather
Stress
Menstrual cycles

Asthma drug therapy
Long-acting and short-acting Beta-agonists
Inhaled corticosteroids
Deep anesthesia
Cromolyn/Nedocromil
Immunomodulators
Leukotriene modifiers
Methylxanthines

What VA would the anesthetist need to avoid in patients with asthma and why?
Isoflurane and Desflurane are airway irritants

What anesthesia technique is considered safer in patients with asthma?
Regional is considered safer than GA

Respiratory implications of a midthoracic or higher spinal or epidural?
Respiratory implications of a midthoracic or higher spinal or epidural?
At these levels, FRC, ERV, and ability to cough decrease and should be avoided

If the anesthetist had no other choice but to use Isoflurane or Desflurance in an asthmatic patient, what can he/she administer to blunt the airway irritant effects of these VA’s?
Opiates can blunt the airway irritant effects of Des or Iso

What volatile anesthetic is LEAST irritating to the airway?
Sevoflurane

Why should the anesthetist avoid Atracurium and Morphine in asthmatic patients?
Due to histamine release

If the anesthetist needed to use Beta-blockers, what factors would guide his/her selection?
Beta-1 selective drugs such as Esmolol can be used

Why should prostaglandins (F2alpha subtype to stop obstetric bleeding) and ergot derivatives be avoided in asthmatic patients?
They increase the risk for bronchospasm

Why would the anesthetist want to avoid Pancuronium in asthmatic patients?
Use of long acting muscle relaxants can cause residual muscle weakness that can precipitate respiratory failure

What is the reasoning behind some clinician’s preference on deep extubation?
Earlier is better to prevent mechanical bronchial stimulation

What medications would you use to decrease airway sensitivity?
IV lidocaine
deep anesthesia
opiates

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